Abstract
Introduction Pituitary adenomas represent 15% of primary brain tumors. Visual disturbance is a
common clinical manifestation of these neoplasms due, among other factors, to local
mass effect on the optic system.
Objective To evaluate changes of the visual fields in patients undergoing endoscopic endonasal
approach (EEA) for pituitary adenomas and to find predictive factors for successful
visual field outcome.
Material and Methods This is a cross-sectional study. A review was conducted of medical records of consecutive
patients with tumors of the sellar region undergoing EEA between January 2008 and
December 2012 at the Skull Base Unit of Guillermo Grant Benavente Hospital, University
of Concepción, Concepción, Chile, and who had undergone pre- and postoperative visual
field evaluation.
Results A total of 35 patients, with a mean age of 50.2 years, fulfilled the inclusion criteria.
All patients had objective visual field disturbances before the surgery. Following
surgery, 25 patients (71.4%) had favorable outcomes, whereas 8 (22.8%) had no change
and 2 (5.8%) had an unfavorable outcome. Complete tumor removal was associated with
a better visual outcome than those obtained after a subtotal removal.
Discussion The EEA for pituitary tumors is particularly effective for visual field disturbances,
with reported improvement rates ranging from 50 to 90%. Our series show similar results,
with a 71.4% improvement of visual field disturbances.
Conclusion This study adds further evidence to the current belief that EEA for pituitary adenomas
is a safe and effective technique to improve visual field alterations. Complete removal
of the tumor during surgery seems to be a predictive factor for a good visual outcome.
Keywords
pituitary - endoscopic endonasal approach - visual field - optic nerve - optic chiasm
